Stenotic Lesions of the Intracranial Arteries in Relation to the Average Level and Variability of the Home Blood Pressure: A Cross-Sectional Study.

Background: This study assessed the presence of intracranial arterial stenosis (ICAS) in relation to home systolic blood pressure (SBP) and its variability (BPV).

Methods: In 1510 untreated patients, ICAS was assessed by transcranial Doppler ultrasonography. SBP and BPV were determined from individual home BP recordings over seven days with triplicate readings in the morning and evening. BP variability was expressed as standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). CV was SD divided by the mean, VIM was SD divided by the mean to the power x  and multiplied by the population mean to the power x, and ARV reflected the average absolute difference between consecutive BP readings. Associations with ICAS were assessed from nested multivariable logistic models.

Results: One hundred and fourteen participants (7.5%) had ICAS. Combining all BP readings, SBP, SD, CV, VIM, and ARV averaged (± between-patient SD) 130.1 ± 11.9 mm Hg, 8.36 ± 2.53 mm Hg, 6.42 ± 1.83%, 8.36 ± 2.38, and 6.41 ± 1.61 mm Hg, respectively. In multivariable-adjusted models, higher home SBP was independently associated with increased prevalence of ICAS. For morning measurements, all variability indices were significantly associated with ICAS, with odds ratios per 1-SD increase ranging from 1.33 to 1.34 (P ≤ 0.005), independent of SBP level. In contrast, associations based on evening variability were non-significant. Sex and anatomical ICAS location did not impact these results.

Conclusions: The prevalence of ICAS was positively associated with SBP level. In addition to the SBP level, all four morning BPV indexes refined the assessment of ICAS prevalence.